Several of my clients with severe back pain have been rocked by medical diagnoses of osteoarthritis, scoliosis, bulging discs, or ankylosing spondylitis (AS). In every case I discovered they had injured muscles, creating tension that misaligned their pelvis and vertebrae.

Osteoarthritis

A 40ish client with severe sciatic pain received an X-ray report that indicated she had osteoarthritis in her lumbar spine.

She was devastated.

She was terrified she’d end up in a wheelchair.

I asked if her family physician had put the diagnosis in context. Osteoarthritis simply means bone inflammation. Osteoarthritis is the result when bone rubs on bone. An X-ray would clearly show (me, not necessarily the radiologist interpreting the scan nor the physician who relied on the written report) that her ilium and lumbar spine were misaligned.

Using manual assessment, I’d discovered my client had an anteriorly rotated ilium. Palpation led me to thigh muscle knots and strains. The excessive tension in the damaged thigh muscles pulled her ilium forward into an anterior rotation. That in turn created functional scoliosis (a lateral curvature) in her lumbar spine and a short leg on the same side as the ilium anterior rotation.

She had lumbar osteoarthritis solely as a result of misaligned vertebrae and pelvic bones. Although she wasn’t feeling it yet, hip damage was progressing. When the femur’s greater trochanter is not seated properly in the hip socket, wear and tear can cause osteoarthritis, bursitis, and ultimately a labral tear.

In the image below, note the lateral curvature of the lumbar spine and attached sacrum. In this case the scoliosis or curvature is caused by the discrepancy in the heights of the ilium bones. Nerves exiting the L4-L5 vertebrae can easily be compressed by the tilted vertebrae and/or anteriorly rotated iliac crest digging into the lower back.

Excess muscle tension causes ilium anterior or posterior rotation, which creates spinal curvature/scoliosis, which causes compression of nerves exiting the vertebrae and possibly bulging discs. The pain is generated by compression of lumbar nerves by tight muscles, by the ilium digging into the back, and/or by the bulging disc(s). Unfortunately very few professionals you’ll encounter understand the link between alignment and back, hip and knee pain. It will be your task to educate them by showing them my blog posts.

Osteoarthritis is not a systemic (body-wide) autoimmune disease like Multiple Sclerosis (MS) or Lupus. I reassured my client that after I restored her ilium and lumbar vertebrae alignment, the osteoarthritis would heal.

Bulging Discs

Compression of the concave sides of two vertebrae can cause the disc in between to bulge. Recall how a hamburger patty between two buns can slide out when your mouth chomps down on one side of the burger. The good news is that, like osteoarthritis, bulging discs can heal when vertebral alignment is restored. Herniated discs do not heal as easily.

Scoliosis

Scoliosis is defined as abnormal curvature of the spine.

André Dückers, a Dutch osteopath and developer of the Energetic Structural Balance workshops, says there are three types of scoliosis:

1. In utero, possibly because of gestational trauma. Some children are born with severe spinal curvature.

   To deal with in utero trauma, André teaches a trauma release technique which I have adapted and now use in my practice to treat mother and child. I teach trauma release workshops in North America.

2. Puberty, caused by rapid, asymmetrical bone growth.

   If a child develops scoliosis during growth spurts, I would first check the pelvis alignment. If it’s out, the cause of the scoliosis is likely to be a sports injury or accident, not asymmetrical rapid bone growth.

3. Acquired due to accident or injury.

   Manual therapy can correct scoliosis caused by physical trauma such as falls, accident or other injury. I’ve treated several children born with normal spines who suffered falls or had been in a vehicle accident. Without my intervention they would have grown up with scoliosis. Without treatment, muscles retain every strain and knot. Severe muscle tension can distort their skeletal alignment. The muscles will retain that tension even as the muscles grow and lengthen. Children can develop chronic inflammation and joint pain. Please do not assume a child will “grow out of it.” The difficulty is finding a therapist with the assessment and therapeutic skills to successfully restore alignment.

Scoliosis Indicators

When a scan shows that one iliac crest is higher than the other, that difference in height results in scoliosis of the spine. The difference in ilium height can be explained by one anterior (forward) ilium or posterior (backward) ilium rotation, or tight back muscles on one side, or any combination.

There are visual indicators as well. Have the person bend over, and observe the curvature of the vertebrae. Is the spine straight from neck to pelvis or is there a lateral curvature as in the images?

A teen client self-diagnosed she had a pelvis alignment problem from looking at herself in the mirror. She noted that the curve at her waist was different on the left versus the right. Observe the difference in the left and right curvatures at the arrows below. That teen had damaged her iliopsoas, causing a one-sided ilium anterior rotation and significant scoliosis.

Ankylosing Spondylitis (AS)

Ankylosing spondylitis is defined as a chronic inflammatory form of arthritis that affects the spine. AS can supposedly cause some of the vertebrae to fuse.

You may be recognizing the blog post theme by this point. In my opinion AS does not “cause” the bones to fuse. Skeletal misalignment does.

Two female clients were diagnosed with AS. In both cases I discovered severe damage in back, iliopsoas and thigh muscles that caused ilium rotations, vertebrae displacement, and scoliosis. Their pain levels were sky high. Both were taking several medications.

When bones are misaligned long enough, asymmetrical/uneven pressure can cause bone to grow into misshapen forms (e.g., bone spurs, vertebral fusion, bunions).

When these female clients were aligned, and the bones were no longer compressing the nerves, their pain was relieved.

Be aware that a diagnosis of AS may actually be a label for the “package” of symptoms of pain, inflammation and fusing of vertebrae. That label does not identify the underlying cause of those symptoms. The underlying cause could be muscle damage and/or skeletal misalignment. Or something else.

Ask your doctor to explain why you have those symptoms. What is causing them? It will take investigation that goes beyond the typical scans, bloodwork, nerve conduction tests, etc. Your doctor will have to take the time to understand your injury history and to look at your overall myoskeletal alignment.

Gout

I had a client who’d been taking gout medication for 40 years for a sore big toe. She told me she’d dropped something on that toe, it developed into chronic pain, and her doctor diagnosed gout.

Gout is a form of inflammatory arthritis characterized by joint pain, commonly affecting the big toes. Excess uric acid in the blood forms needle-shaped crystals in and around the joints, leading to inflammation, pain, and swelling.

In that client’s sore big toe I discovered misaligned bones. The other big toe was fine. In my opinion she had osteoarthritis, not gout. A simple test for uric acid in the blood would confirm if she indeed had gout. I suggested she ask her doctor to review the need for gout medication.

The Arthritis Diagnosis You Do Not Want…

Rheumatoid Arthritis (RA)

RA is an autoimmune and inflammatory disease. The body’s immune system attacks its own tissues. An RA diagnosis is a cause for tears. It’s a systemic disease. That is, it affects the entire body, including organs. Severe inflammation can lead to joint damage, deformity, and disability.

I know many people with severe arthritis in their body’s joints. All their fingers and toes become crippled, not just a couple of fingers, or one hammertoe. That whole body type of arthritis is an autoimmune disease. It is not related to old injuries or myoskeletal alignment issues.

I met a woman who had fallen on her wrist (no fracture), and had subsequently made the rounds of various specialists with regard to wrist pain. She was trying to get her family physician to refer her to a rheumatologist. There are unfortunate people with RA who truly do need to see a rheumatologist. This woman would have been well served by physiotherapy for her injured wrist.

If it is not a systemic issue affecting the entire body (i.e., if pain is only in a specific part of the body), it is not RA, MS, MG, Lupus or another autoimmune disease.

Final Words

You’ll need to find an experienced manual therapist with advanced training to assess whether the origin of your back pain is muscle damage and tension that has created pelvic misalignment, scoliosis and potentially bulging discs. Sadly, as you may have already discovered, stretching a damaged muscle will not restore alignment. Find out why in my other blog posts.

About the Author

Madeline McBride, M.A.Sc., P. Eng., studied civil engineering at Queen’s University and the University of Waterloo. Those mechanics and structural design courses inform her ability to assess in 3D, and problem-solve how muscle tension pulls a client’s skeletal structure out of alignment. Her engineering background, combined with training in Bowen Therapy, John Garfield’s next generation Applied Myoskeletal Therapy (AMT) and André Dücker’s Energetic Structural Balance (ESB), produced this Canadian expert in restoring pelvis and spinal alignment. Madeline is able to resolve recent ilium rotations and related back, hip, knee and neck pain within one to four sessions. Long-standing, complex issues may take longer due to the body’s entrained compensation. Sign up for a workshop or read her blog posts at www.McBridePainClinic.com